Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia.
Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia; National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia.
Clin Nutr. 2022 Oct;41(10):2185-2194. doi: 10.1016/j.clnu.2022.08.011. Epub 2022 Aug 19.
In critical illness, enteral nutrition (EN) is frequently limited by gastrointestinal (GI) dysfunction. The aim of this systematic review and meta-analysis was to determine relationships between enteral calorie delivery and GI dysfunction in critically ill adults.
MEDLINE, EMCARE, EMBASE, and CINAHL databases were searched from 1 January 2000 to 11 August 2021 to identify parallel group randomised controlled trials of an EN intervention that resulted in a significant difference in calorie delivery between groups and reported at least one outcome relating to GI dysfunction. Study groups were categorised as 'higher' or 'lower' calorie delivery and data were extracted on study interventions, GI dysfunction and clinical outcomes. Extracted data were aggregated using a random effects model and presented as risk ratio with 95% confidence intervals. A P-value <0.05 was considered significant. The risk of publication bias was assessed graphically using a funnel plot.
From 13 studies involving 6824 patients the mean calorie delivery in the higher calorie group was 1673 ± 468 kcal/day compared to 1121 ± 312 kcal/day in the lower calorie group. The higher calorie group had an increased risk of a large (any volume ≥300 ml) gastric residual volume (GRV) (RR 1.40; 95% CI 1.09, 1.80; P = 0.009) and prokinetic administration (RR 1.18; 95% CI 1.11, 1.27; P < 0.00001). There were no between group differences in the presence of vomiting/regurgitation (RR 0.93; 95% CI 0.58, 1.49; P = 0.76), diarrhoea (RR 1.12; 95% CI 0.93, 1.35; P = 0.22) or abdominal distension (RR 0.71; 95% CI 0.49, 1.04; P = 0.08). There was no evidence of publication bias.
Higher calorie delivery is associated with increased rates of GRV≥300 ml and prokinetic administration, but not vomiting/regurgitation, diarrhoea or abdominal distension.
No funding was received for the conduct of this systematic review and meta-analysis. The protocol was prospectively registered with PROSPERO (CRD42021268876).
在危重病中，肠内营养（EN）常因胃肠（GI）功能障碍而受到限制。本系统评价和荟萃分析的目的是确定危重病成人中肠内热量输送与 GI 功能障碍之间的关系。
从 2000 年 1 月 1 日至 2021 年 8 月 11 日，检索 MEDLINE、EMCARE、EMBASE 和 CINAHL 数据库，以确定肠内营养干预结果导致两组间热量输送有显著差异并至少报告了一项与 GI 功能障碍相关的结果的平行随机对照试验。将研究组分为“高”或“低”热量输送，并提取研究干预、GI 功能障碍和临床结局的数据。使用随机效应模型汇总提取的数据，并以风险比和 95%置信区间表示。P 值<0.05 被认为具有统计学意义。使用漏斗图评估发表偏倚的风险。
纳入 13 项涉及 6824 名患者的研究，高热量组的平均热量输送为 1673±468 kcal/天，而低热量组为 1121±312 kcal/天。高热量组胃残留量（GRV）≥300ml 的风险增加（RR 1.40；95%CI 1.09，1.80；P=0.009）和使用促动力药物的风险增加（RR 1.18；95%CI 1.11，1.27；P<0.00001）。两组间呕吐/反流（RR 0.93；95%CI 0.58，1.49；P=0.76）、腹泻（RR 1.12；95%CI 0.93，1.35；P=0.22）或腹胀（RR 0.71；95%CI 0.49，1.04；P=0.08）的发生率无差异。无发表偏倚的证据。
高热量输送与更大的 GRV≥300ml 和促动力药物的使用增加有关，但与呕吐/反流、腹泻或腹胀无关。
本系统评价和荟萃分析的进行未获得任何资金支持。该方案已在 PROSPERO（CRD42021268876）上预先注册。
